PREDICTION OF 18-MONTH SURVIVAL IN PATIENTS WITH PRIMARY MYELODYSPLASTIC SYNDROME - A REGRESSION-MODEL AND SCORING SYSTEM BASED ON THE COMBINATION OF CHROMOSOME FINDINGS AND THE BOURNEMOUTH SCORE
V. Parlier et al., PREDICTION OF 18-MONTH SURVIVAL IN PATIENTS WITH PRIMARY MYELODYSPLASTIC SYNDROME - A REGRESSION-MODEL AND SCORING SYSTEM BASED ON THE COMBINATION OF CHROMOSOME FINDINGS AND THE BOURNEMOUTH SCORE, Cancer genetics and cytogenetics, 81(2), 1995, pp. 158-165
The predictive potential of six selected factors was assessed in 72 pa
tients with primary myelodysplastic syndrome using univariate and mult
ivariate logistic regression analysis of survival at 18 months. Factor
s were age (above median of 69 years), dysplastic features in the thre
e myeloid bone marrow cell lineages, presence of chromosome defects, a
ll metaphases abnormal, double or complex chromosome defects (C23), an
d a Bournemouth score of 2, 3, or 4 (B234). In the multivariate approa
ch, B234 and C23 proved to be significantly associated with a reductio
n in the survival probability. The similarity of the regression coeffi
cients associated with these two factors means that they have about th
e same weight. Consequently, the model was simplified by counting the
number of factors (0, 1, or 2) present in each patient, thus generatin
g a scoring system called the Lausanne-Bournemouth score (LB score). T
he LB score combines the well-recognized and easy-to-use Bournemouth s
core (B score) with the chromosome defect complexity, C23 constituting
an additional indicator of patient outcome. The predicted risk of dea
th within 18 months calculated from the model is as follows: 71% (conf
idence interval: 1.7-24.8) for patients with an LB score of 0, 60.1% (
44.7-73.8) for an LB score of 1, and 96.8% (84.5-99.4) for an LB score
of 2. The scoring system presented here has several interesting featu
res. The LB score may improve the predictive value of the B score, as
it is able to recognize two prognostic groups in the intermediate risk
category of patients with B scores of 2 or 3. It has also the ability
to identify two distinct prognostic subclasses among RAEB and possibl
y CMML patients. In addition to its above-described usefulness in the
prognostic evaluation, the LB score may bring new insights into the un
derstanding of evolution patterns in MDS. We used the combination of t
he B score and chromosome complexity to define four classes which may
be considered four possible states of myelodysplasia and which describ
e two distinct evolutional pathways.